Medi-Cal dental reimbursement: house/extended care facility call.

Plain English Breakdown

The exact financial impact on Medi-Cal remains unclear as it depends on various factors including federal approvals and funding availability.

Medi-Cal Dental Reimbursement Increase

This law increases Medi-Cal reimbursement rates for dental services provided in patients' homes or facilities to a minimum rate of $120 per visit and requires reporting on the impact every two years.

What This Bill Does

• Increases the Medi-Cal reimbursement base rate for house/extended care facility calls to at least $120 per patient per date of service.
• Adjusts the rates every two years based on inflation and provider cost data.
• Requires the State Department of Health Care Services to report to the Legislature about the impact of these changes on access, utilization, and emergency dental visits.

Who It Names or Affects

• Medi-Cal patients who need dental services in their homes or facilities.
• Dental providers who offer house/extended care facility calls.
• The State Department of Health Care Services, which administers the Medi-Cal program.

Terms To Know

Medi-Cal

A health insurance program for low-income Californians that covers medical and dental services.

House/extended care facility call

When a dentist visits a patient's home or a special care facility to provide dental treatment.

Limits and Unknowns

• Implementation depends on getting federal approval and funding.
• It is not clear how much more this will cost Medi-Cal.

Official Summary Text

AB 1717, as amended, Castillo.
Medi-Cal dental reimbursement: house/extended care facility call.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including certain dental services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under the Medi-Cal Dental Provider Handbook, the maximum allowance for a house/extended care facility call under a specified billing code is $20.
This bill would require the department to increase the Medi-Cal reimbursement base rate for a house/extended care facility call in order to reflect the reasonable travel costs for purposes of delivering dental services in the patient’s private residence or applicable facility instead of the location of the dental provider.
The bill would
require that the rate be adjusted to a minimum of $120 per patient per date of service, with subsequent readjustments every 2 years to account for inflation and provider cost data.
The bill would require the department, every 2 years, to report to the Legislature about the impact of the rate adjustments on access, utilization, and reductions in emergency department visits for dental conditions.
The bill would condition implementation of these provisions on an appropriation, receipt of any necessary federal approvals, and the availability of federal financial participation.

Current Bill Text

Download Bill PDF